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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019187
Report Date: 12/17/2021
Date Signed: 12/17/2021 04:06:00 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:SHAHIJANIAN FAMILY CHILD CAREFACILITY NUMBER:
198019187
ADMINISTRATOR:SONA SHAHIJANIANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 641-4422
CITY:BURBANKSTATE: CAZIP CODE:
91501
CAPACITY:14CENSUS: 7DATE:
12/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Sona Shahijanian/LicenseeTIME COMPLETED:
04:10 PM
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On 12/17/21 Licensing Program Analyst (LPA), conducted an unannounced Annual Required Inspection and was met by Licensee, Sona Shahijanian. Also present was Staff #1 (S1). Licensee is Armenian Speaking and the visit was conducted in Armenian. Days and hours of operation are Monday to Friday from 7:30 AM to 10:00 PM. Licensee has requested to add one additional bedroom (licensee's son’s bedroom), one bathroom in the bedroom, and the family room as a day care activity room. All rooms were observed to be safe and free of any hazards. Licensee has submitted an updated facility sketch to note the additional rooms as a day care rooms and no longer off-limits. LPA toured the home inside and outside and a census was taken. All areas identified on the facility sketch were inspected. This is a one story home consists of 4 bedrooms, 3 restrooms, living room, dining room, family room, kitchen, laundry room, detached dwelling (1 room and 1 bathroom), front yard, back yard, and side yard (fenced). There is a fireplace in the living room which has been blocked off to prevent access to children.

Areas that are accessible to children are as follows: Bathroom in the hallway, living room, dining room, 2 bedrooms, family room, bathroom in the bedroom, and side yard (fenced).


Areas off limits to children and parents include: kitchen, 2 bedrooms, 2 bathrooms, detached dwelling (1 room and 1 bathroom), laundry room, front yard, and backyard. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. Firearms and ammunition are stored and locked separately. All poisons are kept in a locked storage area. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHAHIJANIAN FAMILY CHILD CARE
FACILITY NUMBER: 198019187
VISIT DATE: 12/17/2021
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 There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. There are currently three infants in care. LPA discussed Safe Sleep Regulations with licensee. There are three play yards for each infant in care, play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the site yard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training was completed on 07/14/21. Licensee’s pediatric CPR/First Aid expires on 02/20/20.

SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHAHIJANIAN FAMILY CHILD CARE
FACILITY NUMBER: 198019187
VISIT DATE: 12/17/2021
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A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are / are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.



LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

Exit interview was conducted.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit. was provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3